Provider Demographics
NPI:1194786152
Name:DANIELS, DEBORAH A (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MANCHESTER EXPRESSWAY
Mailing Address - Street 2:STE F2
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-571-0100
Mailing Address - Fax:706-571-3311
Practice Address - Street 1:2300 MANCHESTER EXPRESSWAY
Practice Address - Street 2:STE F2
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-571-0100
Practice Address - Fax:706-571-3311
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516029AMedicaid
08BDFCNMedicare ID - Type Unspecified
GA00516029AMedicaid